Despite the fact that limited literacy has been found to be a strong predictor of health outcomes and health care utilization patterns across populations and health conditions limited research has examined the relationships among literacy and serious mental illness. Increasing our understanding of the patterns and prevalence of limited literacy among people living with the full range of psychiatric disorders is a necessary step to our understanding of the impact and meaning of limited literacy in the lives of people with mental illness. While the vision of a life in the community for all has been clearly articulated (Department of Health and Human Services, 2003) barriers to recovery and full community participation remain. The role of limited literacy, as one such barrier, has been poorly examined. Increasing our understanding of the role of limited literacy will inform our understandings of disparities experienced by people with serious mental illness (SMI) and efforts to reduce these disparities. This knowledge will also inform the development of treatment and service provision to best meet the needs of those with limited literacy and ultimately improve the capabilities of people living with mental illness to improve health and support full community participation. The goal of this study is to increase our understanding of the prevalence of limited literacy among people using public, urban mental health outpatient services and to examine mechanisms that inform our understanding of these relationships. We will examine the ways in which limited literacy affects the lives of people living with serious mental illness. The specific aims are: Aim 1: to more fully assess the domains of literacy, including reading, aural, and numeracy, among people receiving services at public, urban outpatient mental health clinics. Aim 2: to understand the relationships, and explore mechanisms, among psychiatric disorders, limited literacy and mental health service utilization Aim 3: to examine the impact of limited literacy on the lives and recovery of people living with mental illness. The results of this study will inform and expand multiple fields of research including mental health services research, psychiatric rehabilitation and recovery, and literacy and education. In addition, these findings will provide needed knowledge to be used by those developing programs for people with mental illness and policies to promote health, wellness and participation for people with mental illness. PUBLIC HEALTH RELEVANCE: Inadequate attention has been paid to the role of limited literacy as a barrier to recovery and participation among people with serious mental illness (SMI). The proposed study, relies upon a mixed-methods, service-user informed, research design to examine the multiple domains of limited literacy among people with serious mental illness using public, urban, mental health outpatient clinics. Relationships among limited literacy (reading, aural and numeracy), psychiatric disorder, mental health service utilization and other salient mechanisms will be examined. Finally, the meaning and impact of limited literacy in the lives of people with SMI will be examined.